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Americans’ views about the Patient Protection and Affordable Care Act (PPACA) are more positive now than they were last fall, although overall attitudes remain more negative than positive, according to a new Gallup poll. Half of Americans now disapprove of the 2010 law, while 44% approve –– the narrowest gap since October 2013. By comparison, last November, just after the strong Republican showing in the midterm elections, 56% of Americans disapproved and 37% approved.

Americans’ support of the PPACA has fluctuated substantially in recent years, reaching as high as 48% in November 2012, just after President Barack Obama was re-elected, and dropping to as low as 38% in January 2014 and 37% last November. The latest update, based on interviews conducted April 1–4, shows that Americans have returned to the more positive evaluation of a year and a half ago –– albeit one that remains net negative, Gallup says. The shift in attitudes over the past 4 months may reflect the public’s awareness of data showing that the percentage of Americans who are uninsured has dropped substantially since the PPACA-mandated open enrollment periods for obtaining insurance began to take effect.

Although opinions of the PPACA have become somewhat more positive, Americans’ attitudes about the Act’s effect on their own personal health care have not shown much change. Most Americans continue to say the Act has had no effect on their health care so far, whereas the percentage who say it has hurt their situation continues to be marginally higher than the percentage who say it has helped.

The PPACA was partly designed to help those who could not afford insurance to get it, and the data show that several groups that are least likely to be insured –– younger individuals, those with lower incomes, and minorities –– are at least somewhat more likely to be positive about the effect of the Act than others.

Americans 18 to 29 years of age were slightly more likely than those who were older to say that the PPACA had helped their health care situation or that of their family, but almost 20% said it had made their situation worse. The PPACA mandated that those under 26 years of age could stay on or be added to their parents’ insurance policy, and provided subsidies for younger uninsured Americans to get insurance. On the other hand, the PPACA created a requirement that all Americans have insurance, which could be responsible for some of the more-negative evaluations among this younger group if they were forced to buy insurance they did not want. Most Americans 65 years of age and older are eligible for Medicare, and yet 30% of this group still said that the PPACA had either helped or hurt their health care situation.

Americans with lower incomes have been less likely to be insured than those making more, and a slightly higher percentage of those making less than $24,000 a year said that the PPACA had helped their health care situation than was the case among those with higher incomes.

Blacks and Hispanics were significantly more likely than whites to say that the PPACA had helped them and their family.

When asked about the effect that the PPACA will have on their personal health care situation in the long term, 32% said it will make it worse –– tying the lowest percentage Gallup has measured. This reflects a decline from 38% in October, although these views have fluctuated over the past several years. At the same time, the percentage saying that the PPACA will make no difference in the long run has gone up. About 25% said that it has made their situation better, similar to prior readings.

Americans’ views of the long-term effect of the PPACA on the country have remained stable. In the most recent update, 43% said that it will make things worse for the U.S. health care situation in the long run, whereas 38% said it will make things better. This six-percentage-point gap is identical to the gap in overall attitudes about the law.

Gallup concluded that the PPACA remains controversial. President Obama and many Democrats point to the demonstrable decrease in the percentage of Americans who are uninsured as an indicator of how successful the Act has been. In contrast, Republicans continue to criticize the Act, including Republican presidential candidate Ted Cruz, who last month asked his listeners in his announcement speech to “imagine in 2017 a new president signing legislation repealing every word of Obamacare.”

Results for the poll were based on telephone interviews conducted April 1–4, 2015, with a random sample of 2,040 adults (aged 18 years and older) living in all 50 U.S. states and the District of Columbia.

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